Provider Demographics
NPI:1477677219
Name:CATHOLIC HEALTH INITIATIVES COLORADO
Entity Type:Organization
Organization Name:CATHOLIC HEALTH INITIATIVES COLORADO
Other - Org Name:HEALTH SERVICES CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGNUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-247-4311
Mailing Address - Street 1:1010 THREE SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8296
Mailing Address - Country:US
Mailing Address - Phone:970-247-4311
Mailing Address - Fax:
Practice Address - Street 1:1800 E 3RD AVE
Practice Address - Street 2:STE 109
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4753
Practice Address - Country:US
Practice Address - Phone:970-764-1790
Practice Address - Fax:970-375-7927
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC HEALTH INITIATIVES COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04260048Medicaid
CO04260048Medicaid
CO068508Medicare Oscar/Certification